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1.
JAMA ; 322(5): 438-444, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386141

RESUMO

Importance: Pancreatic cancer is an uncommon cancer with an age-adjusted annual incidence of 12.9 cases per 100 000 person-years. However, the death rate is 11.0 deaths per 100 000 person-years because the prognosis of pancreatic cancer is poor. Although its incidence is low, pancreatic cancer is the third most common cause of cancer death in the United States. Because of the increasing incidence of pancreatic cancer, along with improvements in early detection and treatment of other types of cancer, it is estimated that pancreatic cancer may soon become the second-leading cause of cancer death in the United States. Objective: To update the 2004 US Preventive Services Task Force (USPSTF) recommendation on screening for pancreatic cancer. Evidence Review: The USPSTF reviewed the evidence on the benefits and harms of screening for pancreatic cancer, the diagnostic accuracy of screening tests for pancreatic cancer, and the benefits and harms of treatment of screen-detected or asymptomatic pancreatic cancer. Findings: The USPSTF found no evidence that screening for pancreatic cancer or treatment of screen-detected pancreatic cancer improves disease-specific morbidity or mortality, or all-cause mortality. The USPSTF found adequate evidence that the magnitude of the benefits of screening for pancreatic cancer in asymptomatic adults can be bounded as no greater than small. The USPSTF found adequate evidence that the magnitude of the harms of screening for pancreatic cancer and treatment of screen-detected pancreatic cancer can be bounded as at least moderate. The USPSTF reaffirms its previous conclusion that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms. Conclusions and Recommendation: The USPSTF recommends against screening for pancreatic cancer in asymptomatic adults. (D recommendation).


Assuntos
Carcinoma Ductal Pancreático/diagnóstico , Detecção Precoce de Câncer/normas , Neoplasias Pancreáticas/diagnóstico , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/cirurgia , Efeitos Psicossociais da Doença , Detecção Precoce de Câncer/efeitos adversos , Feminino , Humanos , Masculino , Programas de Rastreamento/normas , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/cirurgia , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade
3.
Stud Health Technol Inform ; 264: 969-973, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438068

RESUMO

Since the eighties, case mix evaluation methods based on diagnosis-related groups (DRG) were gradually introduced in developed countries. These methods of assessing the costs of diseases to measure the productivity of the hospital have been introduced in management softwares that are not accessible to low-income countries. In this study, the authors applied these methods to an open source hospital management information system (HMIS) implemented in three university hospitals in Great Lakes Africa. A comparative study of the financial burden of five major diseases, monitored as part of a universal health coverage (UHC) analysis, was carried out. The level of coverage of patients in the hospitals was evaluated and the impact of UHC policies demonstrated. Although the financial protection of patients treated in the three hospitals had improved, HIV and tuberculosis treatments that ought to be free, remained a considerable financial burden for the patient.


Assuntos
Sistemas de Informação Hospitalar , África , Efeitos Psicossociais da Doença , Hospitais Universitários , Humanos , Cobertura Universal do Seguro de Saúde
4.
Stud Health Technol Inform ; 264: 979-982, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438070

RESUMO

With the characteristics of high incidence, high prevalence and high mortality, stroke has a serious impact on residents' health and imposes a heavy ecomomic burden on China. In order to simulate the economic burden of stroke in the next 20 years, we construct a simulation platform for Chinese stroke economic burden based on the national stroke screening data. We use the Leslie model for population prediction and the equilibrium model to simulate the stroke economic burden in the platform. The platform constructed in this study can dynamically simulate the stroke economic burden during 2020-2040 by computing the incidence, prevelance and mortality rates from the national stroke screening data or as customized by the user. Based on this platform, we can further develop a warning mechanism at the national level, and provide a guide for the planning and allocation of national health resources.


Assuntos
Acidente Vascular Cerebral , China , Efeitos Psicossociais da Doença , Humanos , Incidência , Prevalência
7.
Lancet ; 394(10194): 249-260, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31327369

RESUMO

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.


Assuntos
Saúde Global , Doenças da Boca/epidemiologia , Saúde Pública , Efeitos Psicossociais da Doença , Cárie Dentária/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Doenças da Boca/complicações , Doenças da Boca/economia , Doenças da Boca/terapia , Neoplasias Bucais/epidemiologia , Doenças Periodontais/epidemiologia , Prevalência , Fatores Socioeconômicos
8.
Vasc Health Risk Manag ; 15: 187-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31308682

RESUMO

Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains-epidemiologic, clinical, humanistic, and economic-focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient's physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden-a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Isquemia/economia , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/economia , Doença Arterial Periférica/terapia , Amputação/economia , Estado Terminal , Humanos , Incidência , Isquemia/diagnóstico , Isquemia/epidemiologia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Prevalência , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
Pflege ; 32(4): 209-223, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31311457

RESUMO

Burdens and resources of nurses working in the specialist palliative care: an explorative cross-sectional study Abstract. Background: For Germany, there are no studies so far which compare the burdens and the resources of nurses working in the specialized palliative care settings. AIM: The aim of this study was to analyse and compare burdens and resources of nurses working in palliative care wards, inpatient hospices and in specialized outpatient palliative care services. METHOD: In 2015, nurses from the referred settings in Rhineland-Palatinate were invited to complete a self-developed questionnaire on burdens and resources. Contingency tables, Kruskal-Wallis tests and regressions were calculated. RESULTS: 149 nurses (response rate: 34.5 %) participated in the survey. Nurses working in palliative care wards indicated higher values in all types of burdens than nurses working in hospices and specialized outpatient palliative care. Nurses in palliative care wards and hospices reported emotional burdens as the most stressful factor, while nurses working in specialized outpatient care services expressed the highest levels of burdens in patient-related areas. An association between the experienced amount of burdens and having acquired an additional qualification in palliative care was determined (adjusted Odds Ratio (aOR) for burden due to organizational conditions: 2.56, CI: 1.06 - 6.19; aOR for burden due to support for family members: 2.99, CI: 1.06 - 8.46). The three settings in our study differ in terms of the availability of the resources family, group supervision and additional qualifications. CONCLUSIONS: This study provides an insight into the burdens and the resources of nurses working in palliative care wards, hospices and specialized outpatient palliative care services in Rhineland-Palatinate, Germany. Future preventative measures should be tailored to the respective settings.


Assuntos
Efeitos Psicossociais da Doença , Recursos em Saúde , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Estudos Transversais , Alemanha , Humanos
10.
Health Qual Life Outcomes ; 17(1): 113, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262316

RESUMO

BACKGROUND: Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disorder characterised by recurrent abdominal pain and disturbed bowel habits and unclear aetiology. IBS is also associated with psychosocial factors, impaired quality of life and lost work productivity. This study sought to determine whether the association between IBS and lost work productivity might be accounted for by poor coping strategies and loss of confidence in the healthcare system. METHODS: Case-control design was employed sampling IBS and non-gastrointestinal (non-GI) primary healthcare seekers in a defined region in Sweden. Non-GI patients were of similar age and sex distribution to the IBS patients. Questionnaires applied in this study included instruments designed to measure confidence in the social security system and in the community, as well as questions about whether gastrointestinal problems might affect working life and Sense of coherence (SOC) questionnaire. The study's primary hypothesis was evaluated via an a priori path model. RESULTS: Statistically significant differences were found between IBS cases (n = 305) and controls (n = 369) concerning abdominal pain or discomfort affecting everyday performance at work (p <  0.0001). IBS cases also showed significantly lower (p = 0.001) confidence in public healthcare. The study's hypothesis was supported with the finding of a statistically significant indirect association via poor coping strategies, although the indirect associations were lesser in magnitude than the direct association. CONCLUSIONS: This study found a clear association between clinically diagnosed IBS status and interference in work by gastrointestinal symptoms in which sense of coherence might be of importance.


Assuntos
Atitude Frente a Saúde , Efeitos Psicossociais da Doença , Emprego/psicologia , Síndrome do Intestino Irritável/psicologia , Qualidade de Vida , Dor Abdominal/etiologia , Dor Abdominal/psicologia , Adaptação Psicológica , Adulto , Estudos de Casos e Controles , Eficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Senso de Coerência , Inquéritos e Questionários , Suécia
11.
Lancet ; 394(10193): 160-172, 2019 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-31305254

RESUMO

Adult spinal deformity affects the thoracic or thoracolumbar spine throughout the ageing process. Although adolescent spinal deformities taken into adulthood are not uncommon, the most usual causes of spinal deformity in adults are iatrogenic flatback and degenerative scoliosis. Given its prevalence in the expanding portion of the global population aged older than 65 years, the disorder is of growing interest in health care. Physical examination, with a focus on gait and posture, along with radiographical assessment are primarily used and integrated with risk stratification indices to establish optimal treatment planning. Although non-operative treatment is regarded as the first-line response, surgical outcomes are considerably favourable. Global disparities exist in both the assessment and treatment of adults with spinal deformity across countries of varying incomes, which represents an area requiring further investigation. This Seminar presents evidence and knowledge that represent the evolution of data related to spinal deformity in adults over the past several decades.


Assuntos
Vértebras Lombares/anormalidades , Curvaturas da Coluna Vertebral , Vértebras Torácicas/anormalidades , Adulto , Efeitos Psicossociais da Doença , Humanos , Planejamento de Assistência ao Paciente , Exame Físico , Radiografia , Medição de Risco , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/psicologia , Curvaturas da Coluna Vertebral/terapia , Resultado do Tratamento
12.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 914-920, jul.-set. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005735

RESUMO

Objetivo: Descrever as repercussões psicossociais do Traumatismo Cranioencefálico causado por acidente motociclístico. Métodos: Tratou-se de uma pesquisa descritiva, com recorte longitudinal, de abordagem qualitativa, do tipo estudo de caso. Foram aplicados instrumentos e realizados entrevista semiestruturada e observação no domicílio da paciente. Os dados foram analisados por meio da triangulação, buscando-se linhas de convergência entre eles e interpretados por meio da análise de conteúdo temática. Resultados: Foram apresentados a partir da transcrição da entrevista, posteriormente, agruparam-se os conteúdos por similaridades de significados e desvelaram-se as categorias: "Repercussões psicossociais: dualidade do sim e do não", "Ressignificação da maternidade" e "(Re)valorização da vida". Conclusão: Ficou evidenciado que a paciente não teve nenhuma repercussão ou sequela funcional. Entretanto, percebeu-se que nem sempre as repercussões de um acidente motocilístico são visíveis, pelo contrário, as marcas invisíveis se fazem presentes e, por vezes, são difíceis de serem percebidas pelas vítimas e seus familiares


Objective: To describe the psychosocial repercussions of Cranioencephalic Trauma caused by motorcycle accident. Methods: This was a descriptive research, with a longitudinal cut, of a qualitative approach, of the case study type. Instruments were applied, with a semi-structured interview and observation at the patient's home. The data were analyzed through triangulation, searching for lines of convergence between them and interpreted through the analysis of thematic content. Results: They were presented from the transcription of the interview, later, the contents were grouped by similarities of meanings and the categories were unveiled: "Psychosocial repercussions: duality of yes and no"; "Resignation of motherhood" and "(Re) valorization of life". Conclusion: It was evidenced that the patient had no functional repercussion or sequelae. However, it has been noticed that the repercussions of a motorcycle accident are not always visible, on the contrary, the invisible 'marks' are present and sometimes difficult for the victims and their relatives to perceive


Objetivo: Describir las repercusiones psicosociales del Traumatismo Cráneoencefálico causado por accidente motociclístico. Métodos: Se trata de una investigación descriptiva, con recorte longitudinal, de abordaje cualitativo, del tipo estudio de caso. Se aplicaron instrumentos, realizada entrevista semiestructurada y observación en el domicilio de la paciente. Los datos fueron analizados por medio de la triangulación, buscando líneas de convergencia entre los mismos e interpretados a través del análisis de contenido temático. Resultados: Se presentaron a partir de la transcripción de la entrevista, posteriormente, se agruparon los contenidos por semejanzas de significados y se desvelaron las categorías: "Repercusiones psicosociales: dualidad del sí y del no"; "Resignificación de la maternidad" y "(Re) valorización de la vida". Conclusión: Se evidenció que la paciente no tuvo ninguna repercusión o secuela funcional. Sin embargo, se percibió que no siempre las repercusiones de un accidente motocilístico son visibles, por el contrario, las 'marcas' invisibles se hacen presentes y, a veces, son difíciles de percibir por las víctimas y sus familiares


Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Acidentes de Trânsito , Efeitos Psicossociais da Doença , Traumatismos Craniocerebrais , Ferimentos e Lesões , Motocicletas
13.
Parasite ; 26: 42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31309926

RESUMO

Human trichinellosis is a disease caused by nematode worms of the genus Trichinella. In Italy, as well as in most other European countries, notification of Trichinella infections in humans is mandatory; however, no information is available on the number of cases occurring annually. The aim of the present study was to retrospectively evaluate the burden of trichinellosis in Italy from 2005 to 2016. Hospital discharge records (HDRs) showing the code for trichinellosis (124) were registered and screened. Results were then compared with yearly reports issued by the Italian National Reference Laboratory for Trichinella (NRLT), with reports from the European Centre for Disease Prevention and Control (ECDC), and with literature data. A total of 102 HDRs revealed that the 124 code was erroneously reported in 72 (70.6%) records. Out of the 30 (29.4%) records with a correct diagnosis of trichinellosis, nine cases were reported by HDRs only, 21 cases were documented by both HDRs and the NRLT, whereas the NRLT documented 100 additional cases. In the studied period, the average yearly incidence was 0.01 cases per 100,000 inhabitants. This study highlights the limitations of using HDRs to obtain a clear picture of the prevalence and incidence of trichinellosis in Italy. These findings demonstrate the need to intensify the surveillance system for trichinellosis through the development of an Italian registry. This would allow the identification of patients with severe infections and pauci-symptomatic patients, and would avoid the need for clinical analyses and unnecessary treatments, reducing the resulting economic burden on the Italian National Health Service.


Assuntos
Alta do Paciente/estatística & dados numéricos , Sistema de Registros , Triquinelose/epidemiologia , Animais , Efeitos Psicossociais da Doença , Humanos , Itália/epidemiologia , Prevalência , Estudos Retrospectivos , Trichinella/isolamento & purificação
14.
J Water Health ; 17(4): 499-516, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31313990

RESUMO

Harmful algal blooms (HABs) damage human activities and health. While there is wide literature on economic losses, little is known about the economic impact on human health. In this review, we systematically retrieved papers which presented health costs following exposure to HABs. A systematic review was conducted up to January 2019 in databases such as ScienceDirect and PubMed, and 16 studies were selected. Health costs included healthcare and medication expenses, loss of income due to illness, cost of pain and suffering, and cost of death. Two categories of illness (digestive and respiratory) were considered for health costs. For digestive illness cost, we found $86, $1,015 and $12,605, respectively, for mild, moderate and severe cases. For respiratory illness, costs were $86, $1,235 and $14,600, respectively, for mild, moderate and severe cases. We used Quality-Adjusted Life Years (QALYs) to access the loss of well-being due to illness caused by HABs. We found that breathing difficulty causes the most loss of QALYs, especially in children, with a loss of between 0.16 and 0.771 per child. Having gastroenteritis could cause a loss of between 2.2 and 7.1 QALYs per 1,000 children. Misleading symptoms of illness following exposure to HABs could cause bias in health costs estimations.


Assuntos
Efeitos Psicossociais da Doença , Proliferação Nociva de Algas , Criança , Custos de Cuidados de Saúde , Humanos , Renda , Anos de Vida Ajustados por Qualidade de Vida
15.
Scand J Public Health ; 47(5): 482-491, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31313982

RESUMO

Aims: Productivity losses related to premature cancer mortality have been assessed for most developed countries but results for Russia are limited to cross-sectional reports. The aim of this study was to quantify productivity costs due to cancer mortality in Russia between 2001 and 2015 and project this to 2030. Methods: Cancer mortality data (2001-2015) were acquired from the State Cancer Registry, whereas population data, labour force participation rates and annual earnings were retrieved from the Federal State Statistics Service. Cancer mortality was projected to 2030 and the human capital approach was applied to estimate productivity losses. Results: The total annual losses increased from US6.5b in 2001-2005 to US$8.1b in 2011-2015, corresponding to 0.24% of the annual gross domestic product. The value is expected to remain high in 2030 (US$7.5b, 0.14% of gross domestic product). Productivity losses per cancer death are predicted to grow faster in women (from US$18,622 to US$22,386) than in men (from US$25,064 to US$28,459). Total losses were found to be highest for breast cancer in women (US$0.6b, 20% of overall losses in women) and lung cancer in men (US$1.2b, 24%). The absolute predicted change of annual losses between 2011-2015 and 2026-2030 was greatest for cervix uteri (+US$214m) in women and for lip, oral and pharyngeal cancers in men (+US$182m). Conclusions: In Russia, productivity losses due to premature cancer mortality are substantial. Given the expected importance especially for potentially preventable cancers, steps to implement effective evidence-based national cancer control policies are urgently required.


Assuntos
Efeitos Psicossociais da Doença , Eficiência , Mortalidade Prematura , Neoplasias/economia , Neoplasias/mortalidade , Feminino , Humanos , Expectativa de Vida , Masculino , Federação Russa/epidemiologia
16.
Artigo em Alemão | MEDLINE | ID: mdl-31273415

RESUMO

BACKGROUND: Little is known about the utilization of individual health services performed by a physician (IGeL) and the services and supplements provided outside a doctor's office (MuPaP) for osteoarthritis patients. OBJECTIVES: The aims of this study are to analyze the use of osteoarthritis-specific IGeL and MuPaP as well as predictors for their utilization. MATERIALS AND METHODS: For this cross-sectional study, claims data was used to identify all persons with hip, knee, or polyarticular osteoarthritis in 2014 (n = 657,807). A random sample (n = 8995) was sent a questionnaire about their usage of IGeL and MuPaP. Furthermore, the type of physicians conducting or recommending services was evaluated. Applying multivariable logistic regression, predictors associated with the utilization of IGeL, MuPaP, and overall individual health services were analyzed. RESULTS: After validating the data and osteoarthritis diagnosis, 2363 persons were enrolled (mean age: 65.5 years, 72% female). In the last 12 months, 39% of patients had used at least one IGeL (MuPaP: 76%), with 86% being primarily performed by orthopedists (MuPaP: 88% patient self-motivated). Knee osteoarthritis was associated with increased utilization of IGeL. Having female gender, higher income, residence in Western Germany, higher disease burden, and lower satisfaction with the healthcare system were influences on the use of overall individual health services. CONCLUSIONS: Since patients with high disease burden in particular tend to use these therapies with varying treatment success, detailed information, especially about the risks and existing evidence, should be a prerequisite for trustworthy doctor-patient relationships.


Assuntos
Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Osteoartrite/terapia , Demandas Administrativas em Assistência à Saúde , Idoso , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Estudos Transversais , Feminino , Alemanha , Acesso aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Osteoartrite/diagnóstico , Classe Social , Inquéritos e Questionários
17.
Artigo em Alemão | MEDLINE | ID: mdl-31297549

RESUMO

BACKGROUND: Currently, there are 1.7 million people living with dementia (PwD) in Germany. This number is expected to double within the next decades. Estimates of the total societal economic burden of dementia are currently missing. OBJECTIVES: The aim was to estimate the current and future total cost and excess cost of dementia from a public payer and societal perspective. METHODS: Studies demonstrating the healthcare resource utilization of PwD in Germany were identified. Utilization data were aggregated using the sample size of different studies as a weight. Annual per capita costs of PwD and excess cost of dementia were calculated using standardized unit costs. Current and future costs were calculated based on published prevalence and population forecasts. RESULTS: PwD living at home had lower costs from a payer perspective compared to those who are institutionalized, but higher total societal cost due to the higher informal care time. The total cost for PwD from a payer perspective was 34 billion € in 2016. These costs could reach 90 billion € by 2060. The excess cost of dementia was 18 billion € in 2016 and is estimated to become 49 billion € by 2060 from a payer perspective, representing 54% of the total cost of PwD and up to 15% of the total costs associated with the elderly population. The total societal cost was 73 billion € in 2016 and is estimated to become 194 billion € by 2060. The excess cost of dementia was 54 billion € in 2016 and is estimated to become 145 billion € by 2060, representing 74% of the total societal cost of PwD and 36% of the total societal cost of the elderly. CONCLUSION: Dementia diseases represent a tremendous social and economic burden. Without a cure, supporting caregivers and implementing interventions that delay the functional and cognitive decline will be crucial to relieving the increasing costs.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/economia , Demência/psicologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Cuidadores/estatística & dados numéricos , Alemanha , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Alocação de Recursos
19.
MMWR Morb Mortal Wkly Rep ; 68(22): 494-499, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170127

RESUMO

In the United States in 2019, an estimated 16.9 million persons are living after receiving a cancer diagnosis (1). These cancer survivors face many challenges, including functional limitations, serious psychological distress (2), and other lasting and late effects of cancer treatments. Because of the high cost of cancer therapy, many cancer survivors are more likely to face substantial out-of-pocket health care expenditures and financial hardship, compared with persons without a history of cancer (3,4). Out-of-pocket expenditures and financial hardship associated with cancer have been higher among survivors aged 18-64 years than they have been among older survivors (5). To estimate annual out-of-pocket expenditures and financial hardship among cancer survivors aged 18-64 years, compared with persons without a cancer history, CDC, the American Cancer Society, and the National Cancer Institute analyzed data from the 2011-2016 Medical Expenditure Panel Survey (MEPS).* The average annual out-of-pocket spending per person was significantly higher among cancer survivors ($1,000; 95% confidence interval [CI] = $886-$1,113) than among persons without a cancer history ($622; CI = $606-$639). Financial hardship was common; 25.3% of cancer survivors reported material hardship (e.g., problems paying medical bills), and 34.3% reported psychological hardship (e.g., worry about medical bills). These findings add to accumulating evidence documenting the financial difficulties of many cancer survivors. Mitigating the negative impact of cancer in the United States will require implementation of strategies aimed at alleviating the disproportionate financial hardship experienced by many survivors. These strategies include systematic screening for financial hardship at cancer diagnosis and throughout cancer care, integration of discussions about the potential for adverse financial consequences of treatments in shared treatment decision-making, and linkage of patients and survivors to available resources to ensure access to high-quality evidence-based care.


Assuntos
Sobreviventes de Câncer , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Neoplasias/economia , Adolescente , Adulto , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estados Unidos , Adulto Jovem
20.
Cent Eur J Public Health ; 27(2): 93-98, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31241282

RESUMO

OBJECTIVE: Chronic HCV infection is associated with cirrhosis of the liver, hepatocellular carcinoma (HCC), and liver transplantation. HCV disease burden and the impact of new potent direct acting antivirals (DAAs) in the Czech Republic are unknown. METHODS: Using a modelling framework, HCV disease progression in the Czech Republic was predicted to 2030 under the current standard of care treatment structure. In addition, two strategies to reduce the future burden of HCV infection were modelled: an incremental increase in treatment annually and WHO targets. RESULTS: The number of viremic infected individuals in the Czech Republic is estimated to peak in 2026 (n = 55,130) and to decline by 0.5% by 2030 (n = 54,840). The number of individuals with compensated cirrhosis (n = 1,400), decompensated cirrhosis (n = 80), HCC (n = 70), and liver-related deaths (n = 60) is estimated to more than double by 2030. Through aggressive increases in diagnosis and treatment, HCV related mortality may decrease by 70% by 2030. CONCLUSIONS: Disease burden associated with chronic HCV infection is projected to peak in the Czech Republic in 30-40 years. Assuming that the current portion of DAAs used remains constant, a significant reduction in HCV disease burden is possible through increased diagnosis and treatment through 2030. This analysis provides evidence in order to facilitate the development of national strategies for HCV care and management in the Czech Republic.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/epidemiologia , Efeitos Psicossociais da Doença , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Cirrose Hepática/epidemiologia , Neoplasias Hepáticas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antivirais/economia , República Tcheca , Hepatite C Crônica/economia , Humanos , Transplante de Fígado , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Resultado do Tratamento
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